Provider Demographics
NPI:1811034028
Name:CHRISTENSEN, LINDA JOYCE (PT)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:JOYCE
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4136 BACHMAN PL
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2028
Mailing Address - Country:US
Mailing Address - Phone:619-297-2544
Mailing Address - Fax:619-297-2752
Practice Address - Street 1:4120 WEST POINT LOMA BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110
Practice Address - Country:US
Practice Address - Phone:619-297-2544
Practice Address - Fax:619-297-2752
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT7388174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT7388OtherCA LICENSE #
CAR37322Medicare UPIN
CAPT7388Medicare ID - Type Unspecified